04.14.20 COVID-19 Briefing Live Stream Transcript

The County of Santa Clara
April 14, 2020
Live Stream - Live with the County of Santa Clara
11am PT

Dr. Sara Cody: Good morning everyone, I'm Dr. Sara Cody, Health Officer for the County of Santa Clara. And I'm here today just to give you a very brief update about where we are in the county and then I'd be happy to answer some questions briefly.

So, what we're seeing right now we're about a month into our shelter in place order and again, that's the order that we have around the Bay Area, the six core counties around the Bay Area, we're looking at our data every day as I'm sure you are as well on our website. And what we're seeing is we have reason for cautious optimism. So, I would say we're not out of the woods but we are making the progress and slowing things down in the way that we had anticipated that we would with a shelter-in-place order.  So, the number of cases that we see every day are somewhat stable. They're usually in the 50 to 100 new cases a day. We are seeing the deaths increase, although slowly.  So, what this tells us is that the big tool that we had available to us which was to issue a shelter in place and do everything we could both through order, and through encouragement, and through collective action to slow things down.

So, the collective sacrifice and action that everyone has taken across the county has been protective.  However, I want to emphasize that we are by no means out of the woods.  We're still probably at the beginning of what is going to be a very long marathon here in the county, across the region, and indeed across the country.  So, what we are doing right now here in our county, in the region, and across the state is thinking very carefully about what do we need to have in place in order to ease this very broad mitigation this very broad shelter in place.  And I know that this is what everyone is talking about and everyone is thinking about. It's enormously complicated but basically what it looks like is we would not want that, as I mentioned, that the shelter in place is our is our major tool but as you know it's not very focused and so the question is how can we transition to more focused measures?

In order to do that one, we need to make sure that the hospital capacity, that we have given time for hospitals to create, we have to ensure that it's adequate.  And that's not just beds but of course that's staff and that staff that are protected and those staff need adequate quantities of personal protective equipment and they need to have a reasonable and safe supply.

Second, as we know, we have not had sufficient capacity for testing. Now that we understand that there's a significant degree of asymptomatic cases, you can have an infection and no symptoms at all, as well as the understanding that people can become infectious up to two days before they start having symptoms.

All of that tells us that in order to identify people who are infected and infectious, we need more widespread testing and this is something where we're endeavoring to understand what are the levers that we have locally to increase capacity and to what extent do we need to extend on partners at the
state and national level and in the private sector.

Third, we really need to not just here in our region but of course across the state and across the country, we need to ensure that we have the capacity to do case investigation and contact investigation. And remember at the very beginning of this epidemic that is where we had all of our resources.

We had huge teams. We had colleagues from the Centers for Disease Control here embedded with us where we carefully followed every case in every contact. We can't do it the way that we did it at the beginning of the outbreak our case numbers are too high but once we begin to settle those case numbers down then we can transition to a more focused effort. As you could imagine, all of this takes enormous planning and it takes time and so we're using our time now while we have the shelter in place order to do that planning and we're doing it in collaboration as always with our colleagues around the region and around the state because we're a very interconnected society and we obviously can't do this alone. So that's where we are again our take-home messages are that the collective action here in our county and across the Bay Area has increased safety.

It has lengthened the doubling time. It has settled things but it's not enough.  We're a month in and we need to keep at it for a bit longer. Thank you and I'm happy to answer a few questions.

Reporter: Dr. Cody, can you tell us who is going to make the final call for Santa Clara County? We're hearing that President Trump says he's going to make it. The governor is already announcing today some strategies for when restrictions are lifted. Are you going to make the final call for this county? Who is going to make the final call for Santa Clara County?

Cody: In California, there's a much authority that's given to the local health officer. So, you'll remember in March, I started issuing orders.

First, we had recommendations, then we had urgent recommendations, and then we had Health Officer orders. So, the first order as you may recall was to ban gatherings greater than a thousand, and then we scoped that down to greater than a hundred, and then ultimately issued the shelter-in-place order on March 16th.

So, health officers in California have quite a bit of power and authority to protect the health of the population.  In general, and I would say the state health officer, also has powers but in general the way
it works is that if a County Health Officer decides that to protect the population, that we need to be say more conservative or more restrictive than we can be, a state order might be less restrictive than then a county order.

I don't think I've ever, I can't think of an example where a state health officer has issued an order that supersedes a county's, to make them less restrictive.

Reporter: So, can you just clarify those criteria that you just mentioned to us today? Is that, in your mind, what you need to see happen before you would feel comfortable easing restrictions?

Cody: So, these are not so much, they're not specific criteria. Notice I didn't give you any specific metrics. These are, I want to make sure that I communicate to you all and to the public so you that you understand the different areas where we're looking very closely.

So that we can know and have a way to measure where we are and sort of the level of protection for our community. I also just want to acknowledge that all of these decisions are all extraordinarily difficult decisions because we're trying to understand what the impact of each decision is going to be. And of course, the shelter-in-place order, while we do have good evidence that it slowed the infection down and reduced harms from COVID-19.

Of course, we also know that there are harms from the shelter in place. There are health harms from the shelter in place both from social disruption, from economic disruption, and even more immediately for example, if someone doesn't feel like they want to go in access preventive healthcare. So, we're trying to as best we can understand the impacts and then navigate a course that to the greatest extent possible minimizes the harms and as is most protective but it's a very that it's a very complex set of decisions.

Reporter 2: Dr. Cody, what are your thoughts on a mandatory mask order? We've seen them go into effect in Contra Costa County to a certain degree. Have you thought about that? Where are you with that?

Cody: So, as you, know we have recommended universal face covering. We have not used the word masking for a very particular reason and that is because we're sensitive to the fact that we don't have adequate personal protective equipment. And unfortunately, we're still needing to make decisions and communicate our priorities for personal protective equipment which includes medical grade masks.

However, we do have some evidence that covering your mouth and nose when you're out and about and around others, does add a layer of protection. That in addition to social distancing and
frequent hand-washing and other hygiene measures.

Reporter 2: So, for now it's a recommendation?

Cody: For now, it's a recommendation. A strong recommendation.

Reporter 3: Dr. Cody, the county already put out the call for inventory on PPE and what not. Have you gotten any indication if people, corporations, and individuals are complying with that order? And are you encouraged by those number that you're seeing in terms of available inventory?

Cody: So, the due date for the survey is April 15th. So, we don't have all the data in. But I want to link that back to a comment that I made earlier. So, in order to plan we really need to understand our lab testing capacity, our PPE supply, as well as our staffing and resources for case and contact investigation.

So that health officer order is in service to giving us good awareness about our PPE supply so that
we can think about whether we're making recommendations or orders regarding PPE use and whether we have adequate supply within our healthcare delivery system to be more broad. But at this point I don't have those data. I'm very anxious and eager to look at those data.

Once we get them though, we're not going to know instantly tomorrow about what things look like because it's going to take quite a bit of data cleaning and analysis to really understand what the countywide situation looks like.

Reporter 3:  Can you just address about the testing? you've talked about the need for more testing. How many tests have been completed in Santa Clara County? How many more do we need and who are you recommending get tested?

Cody: So, I'm pleased to say that we are doing everything we can to get data up on our website so that everyone can see it. And we do have a laboratory testing dashboard. We are able to post those data
because we in collaboration with the other counties in the Bay Area have an order so that labs have to report to us not just the positives but the negatives. And that enables us to see of all the testing done what's our positivity rate. It also enables us to see how many tests countywide are being done every day and so we can look at those trends.  And that is posted on our website.

Reporter 4:  Dr. Cody, taking a look at the dashboard, the number of cases are broken down by city. You can see that the City of San Jose has more number of cases. Can you talk to us about some contributing factors that might be leading to the higher number of cases in San Jose as opposed to other Santa Clara County cities?

Cody: Right, so we know that San Jose represents the majority of the population in the county, over 50% and San Jose represents the majority of confirmed cases of COVID-19.  The answer to your question is very complicated.

What we are trying to understand by sifting through our data is to understand are there populations at
greatest risk and are there places or communities in our county where the virus is circulating and amplified more quickly than in other places. That's really the key question.

And in order to answer it we have to understand a number of factors including does this represent, for example, increased testing is that why we're seeing more? You know is that a confounding factor or do these numbers represent a local outbreak that are skewing the numbers etc, etc.  So, we're trying to understand these data and I don't have a complete answer for you unfortunately.

Moderator: We did have one more final quick question for you Dr. Cody before you
leave for your next appointment.

Reporter 4: How do we know that there won't be a resurgence of the virus if or when restrictions are lifted?

Cody: So, one of the great challenges, of course, it's been an enormous challenge to live
under the shelter in place. It's been enormously disruptive for everyone living under shelter in place.  I think we all recognize that. We also recognize that we do not want to slip back.  We've made progress, we've settled things down, we need to settle things down more.  And that is why I think that if we just lifted the shelter in place and went back up about our business we'd be right back where we were very quickly. And that's why we need to one, make sure that we're very confident that things are continued to trend in a downward direction and two, we need to make sure that we have all of the resources in place to do careful more focused strategies before we lift the broad shelter in place.

Moderator: Thank you Dr. Cody. Thank you everyone.

Cody: Thank you.